Provider Demographics
NPI:1780652826
Name:BLASINI-TORRES, MARINO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARINO
Middle Name:
Last Name:BLASINI-TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364626
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4626
Mailing Address - Country:US
Mailing Address - Phone:787-728-2318
Mailing Address - Fax:787-728-2359
Practice Address - Street 1:611 CALLE PAVIA
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2239
Practice Address - Country:US
Practice Address - Phone:787-728-2318
Practice Address - Fax:787-728-2359
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8621207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD26943Medicare UPIN
PR0020935Medicare ID - Type UnspecifiedMEDICARE PROV NUM